Learning Ultrasound Guided Fine-Needle Aspiration of Thyroid and Head and Neck Lesions: A Practical Teaching Model for Pathology Residents

Abstract Mount Sinai Downtown has a unique cytopathologist-run ultrasound-guided fine-needle aspiration (FNA) clinic where residents complete a 4-week rotation and perform ultrasound-guided FNAs under direct supervision, in addition to palpable FNAs. Here we share our resident education model for learning ultrasound-guided FNAs. Step 1: Practice on a model We use the Blue Phantom soft tissue model, which contains 16 hyperechoic, hypoechoic, and echolucent masses of varying sizes (ranging from 4 mm to 11 mm), allowing residents to develop their skills, starting with larger lesions and targeting smaller masses as their skills progress. Residents use a needle with a 10-mL syringe (an FNA Cameco syringe holder can be used, as per user preference) to practice needle insertion techniques (parallel vs perpendicular) and also get used to holding the probe in one hand and needle in the other; this helps in learning the hand-eye coordination needed for ultrasound-guided procedures. We recommend practicing placing the phantom on the ENT examination chair with appropriate height adjustment, to have a real-life practice. Step 2: Review courses We recommend reviewing head and neck anatomy and having a thyroid ultrasound review course. This can be accomplished by arranging a session with the in-house radiology department or alternatively by reviewing online resources (eg, thyroid ultrasound course video by the American Thyroid Association, https://www.youtube.com/watch?v = JGG11mc25fg). Step 3 Arrange for a volunteer for ultrasonic examination to familiarize with head and neck anatomy. Step 4 Practice on real patients. Initially, the first few ultrasound-guided FNAs (preferably 5) should be performed on enlarged (>2 cm) and superficial solid/cystic thyroid nodules and the supervising cytopathologist should hold the ultrasound probe so the resident can focus on needle insertion techniques, needle angling, and sample collection. Once hand-eye coordination has improved, the resident can take solo control of the procedure. Note: familiarizing with the consenting process is paramount to answering questions about the patient concerns. We recommend reading online resources like https://www.radiologyinfo.org/en/info.cfm?pg = thyroidbiopsy.